Provider Demographics
NPI:1548405970
Name:WCRX PHARMACY CENTRAL
Entity Type:Organization
Organization Name:WCRX PHARMACY CENTRAL
Other - Org Name:WCRX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM.D
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:INWANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-222-1963
Mailing Address - Street 1:100 SALEM CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2810
Mailing Address - Country:US
Mailing Address - Phone:850-222-1963
Mailing Address - Fax:850-224-9356
Practice Address - Street 1:100 SALEM CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2810
Practice Address - Country:US
Practice Address - Phone:850-222-1963
Practice Address - Fax:850-224-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
FLPH240853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121105OtherPK
FL000970500Medicaid